Introduction and objectives Cardiovascular comorbidity is common in COPD. Retrospective health informatics studies have shown putative benefits of beta-blockers (BB) in reducing both mortality and exacerbations in COPD.1 BB are established in heart failure (HF) guidelines including those patients who have concomitant COPD. However, there remain concerns regarding bronchoconstriction in COPD even with cardio-selective BB. For example, 55% of patients with COPD, who had a myocardial infarction (MI), were not prescribed a BB.2 We wished to assess the use of BB for patients with HF who also have COPD.
Methods The Optimum Patient Care Research Database was used to identify QOF codes for 104,945 patients with COPD, 24,413 with HF and 13,421 with both conditions, where there was at least 1 year of data. We evaluated co-prescribing of BB with either ACE-inhibitor (ACEI) or Angiotensin-2 receptor blockers (ARB) in patients with HF/COPD and their association with inhaler therapy. Heart failure treatments were compared between groups using multinomial logistic regression.
Results In patients with HF/COPD, mean age was 79 years, 60% males and 27% had prior MI. 21.6% of patients with HF and COPD (n = 2,984) were taking a BB in conjunction with either ACEI/ARB as compared to 42.2% of patients with HF alone (n = 10,303) (p < 0.001). In HF/COPD patients on triple inhaler therapy with ICS/LABA/LAMA there were 46.5% taking ACEI/ARB without BB (n = 1,292) verses 29.3% taking ACEI/ARB with BB (n = 813) (odds ratio [OR] = 1.59, 95% CI 1.46, 1.74, p < 0.001). Corresponding figures for those patients on dual inhaler therapy with ICS/LABA were 47.3% (n = 1,275) verses 22.2% (n = 599) respectively (OR = 2.13, 95% CI 1.93, 2.35, p < 0.001).
Conclusions Taken together these data therefore provide strong evidence of an unmet need in COPD patients who should be prescribed beta-blockers more often for concomitant HF.
References 1 Short PM, Lipworth SI, Elder DH, Schembri S, Lipworth BJ. Effect of beta blockers in treatment of chronic obstructive pulmonary disease: a retrospective cohort study. BMJ 2011;342:d2549
2 Quint JK, Herrett E, Bhaskaran K, et al. Effect of β blockers on mortality after myocardial infarction in adults with COPD: population based cohort study of UK electronic healthcare records. BMJ 2013;347:f6650